Hyperhidrosis treatment

Written by Dr Jill Tomlinson on 06 February 2013.

Hyperhidrosis is the medical term for excessive sweating. Excessive sweating can have major effects on your professional or personal life. In most instances there is no medical reason for the excessive sweating, but there are effective treatments available. This treatment is most commonly used for axillary hyperhidrosis (the medical term for "excessive sweating of the armpits") and palmar hyperhidrosis ("excessive sweating of the hands").

Can you stop my palms and/or armpits from sweating?

Yes. Botulinum toxin is a very effective method of stopping excessive sweating.

How does it work?

The botulinum toxin is administed to the affected skin with multiple injections that are spaced out over 1cm areas. The treatment reduces sweating by 90% by blocking signals between the nerves and sweat glands.

Will it work on me?

Almost certainly. Multiple medical studies have demonstrated the safety and efficacy of this treatment. Occasionally patients report that they have had ineffective treatments done elsewhere previously. It is much more likely that in these instances the treatment was not administed correctly, or that an inadequate amount of botulinum toxin was administered. It is extremely unlikely that you are “resistant” or “immune” to botulinum toxin.

How often does treatment need to be repeated?

Is it painful?

Discomfort can be minimised for treatment of the armpits by using combinations of ice, distraction and local anaesthetic cream. Local anaesthetic injections are not used in the armpits as the nerves supplying the area are spread out over a relatively wide area.

For injections to the hands two wrist injections are all that you will feel for a full single hand treatment. As a plastic, reconstructive and hand surgeon I am experienced in administering local anaesthetic nerve blocks. I find that using local anaesthetic provides significantly greater comfort for my hand patients than using ice or other anaesthetic or distraction methods. The hands are very sensitive and I don’t wish to put my patients through the distress of feeling 30-50 separate injections. However, please note that you will not be able to drive home from your appointment!

Is it expensive?

The cost of treatment relates to the large volumes of botulinum toxin that need to be administered for an effective treatment. Patients who experience significant problems with hyperhidrosis find this treatment a lifesaver.

Alternative therapies

Before trying botulinum toxin it is advisable to try simple treatments first. Anti-perspirants that have a high aluminium content work by forming a gel plug in the duct of the sweat gland, blocking the sweat gland. Brand names of products that have a high concentration (15% or greater) include Maxim, Drysol, CertainDri, Odaban, Anhydrol Forte, Dricolor and B+Drier.

Iontophoresis is a non-invasive electronic device that temporarily blocks the sweat ducts. The device can be used every few days for a period of 20-30 minutes to alleviate the problem.

Thoracoscopic sympathectomy is a surgical procedure that can be performed to permanently address excess sweating. Information from practitioners who practice this procedure advises that it is 80% effective. It requires a general anaesthetic and can have significant side effects such as nerve damage, scarring and compensatory hyperhidrosis.

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This website is authored by Dr Jillian Tomlinson, a fully qualified plastic, reconstructive and hand surgeon who practices in Melbourne, Australia. This website aims to inform patients and health professionals about hand surgery, illness prevention and the practice philosophy of Dr Jill Tomlinson. This website's content is designed to complement, not replace, the relationship between a patient and his/her own doctor. The information is not intended to replace the advice of a health professional. This website does not host or receive funding from advertising or from the display of commercial content.